Development of a real-time classifier for the identification of the Sit-To-Stand motion pattern

The Sit-to-Stand (STS) movement has significant importance in clinical practice, since it is an indicator of lower limb functionality. As an optimal trade-off between costs and accuracy, accelerometers have recently been used to synchronously recognise the STS transition in various Human Activity Recognition-based tasks. However, beyond the mere identification of the entire action, a major challenge remains the recognition of clinically relevant phases inside the STS motion pattern, due to the intrinsic variability of the movement. This work presents the development process of a deep-learning model aimed at recognising specific clinical valid phases in the STS, relying on a pool of 39 young and healthy participants performing the task under self-paced (SP) and controlled speed (CT). The movements were registered using a total of 6 inertial sensors, and the accelerometric data was labelised into four sequential STS phases according to the Ground Reaction Force profiles acquired through a force plate. The optimised architecture combined convolutional and recurrent neural networks into a hybrid approach and was able to correctly identify the four STS phases, both under SP and CT movements, relying on the single sensor placed on the chest. The overall accuracy estimate (median [95% confidence intervals]) for the hybrid architecture was 96.09 [95.37 - 96.56] in SP trials and 95.74 [95.39 \u2013 96.21] in CT trials. Moreover, the prediction delays ( 4533 ms) were compatible with the temporal characteristics of the dataset, sampled at 10 Hz (100 ms). These results support the implementation of the proposed model in the development of digital rehabilitation solutions able to synchronously recognise the STS movement pattern, with the aim of effectively evaluate and correct its execution

Quantitative Comparison of Human and Software Reliability in the Categorisation of Sit-to-stand Motion Pattern

The Sit-to-Stand (STS) test is used in clinical practice as an indicator of lower-limb functionality decline, especially for older adults. Due to its high variability, there is no standard approach for categorising the STS movement and recognising its motion pattern. This paper presents a comparative analysis between visual assessments and an automated-software for the categorisation of STS, relying on registrations from a force plate. 5 participants (30 +/- 6 years) took part in 2 different sessions of visual inspections on 200 STS movements under self-paced and controlled speed conditions. Assessors were asked to identify three specific STS events from the Ground Reaction Force, simultaneously with the software analysis: the start of the trunk movement (Initiation), the beginning of the stable upright stance (Standing) and the sitting movement (Sitting). The absolute agreement between the repeated raters' assessments as well as between the raters' and software's assessment in the first trial, were considered as indexes of human and software performance, respectively. No statistical differences between methods were found for the identification of the Initiation and the Sitting events at self-paced speed and for only the Sitting event at controlled speed. The estimated significant values of maximum discrepancy between visual and automated assessments were 0.200 [0.039; 0.361] s in unconstrained conditions and 0.340 [0.014; 0.666] s for standardised movements. The software assessments displayed an overall good agreement against visual evaluations of the Ground Reaction Force, relying, at the same time, on objective measures

Robustness and static-positional accuracy of the SteamVR 1.0 virtual reality tracking system

The use of low-cost immersive virtual reality systems is rapidly expanding. Several studies started to analyse the accuracy of virtual reality tracking systems, but they did not consider in depth the effects of external interferences in the working area. In line with that, this study aimed at exploring the static-positional accuracy and the robustness to occlusions inside the capture volume of the SteamVR (1.0) tracking system. To do so, we ran 3 different tests in which we acquired the position of HTC Vive PRO Trackers (2018 version) on specific points of a grid drawn on the floor, in regular tracking conditions and with partial and total occlusions. The tracking system showed a high inter- and intra-rater reliability and detected a tilted surface with respect to the floor plane. Every acquisition was characterised by an initial random offset. We estimated an average accuracy of 0.5 +/- 0.2 cm across the entire grid (XY-plane), noticing that the central points were more accurate (0.4 +/- 0.1 cm) than the outer ones (0.6 +/- 0.1 cm). For the Z-axis, the measurements showed greater variability and the accuracy was equal to 1.7 +/- 1.2 cm. Occlusion response was tested using nonparametric Bland-Altman statistics, which highlighted the robustness of the tracking system. In conclusion, our results promote the SteamVR system for static measures in the clinical field. The computed error can be considered clinically irrelevant for exercises aimed at the rehabilitation of functional movements, whose several motor outcomes are generally measured on the scale of metres

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Ecological Gait as a Fall Indicator in Older Adults: A Systematic Review

Falls represent a major threat for elders, affecting their life quality and expectancy. Clinical tests and questionnaires showed low diagnostic value with respect to fall risk. Modern sensor technology allows in-home gait assessments, with the possibility to register older adults' ecological mobility and, potentially, to improve accuracy in determining fall risk. Hence, we studied the correlation between standardized assessments and ecological gait measures, comparing their ability to identify fall risk and predict prospective falls

Computer-Mediated Therapies for Stroke Rehabilitation: A Systematic Review and Meta-Analysis

Objective: To evaluate the efficacy of different forms of virtual reality (VR) treatments as either immersive virtual reality (IVR) or non-immersive virtual reality (NIVR) in comparison to conventional therapy (CT) in improving physical and psychological status among stroke patients. Methods: The literature search was conducted on seven databases: ACM Digital Library, Medline (via PubMed), Cochrane, IEEE Xplore, Web of Science, Scopus, and science direct. The effect sizes of the main outcomes were calculated using Cohen's d. Pooled results were used to present an overall estimate of the treatment effect using a random-effects model. Results: A total of 22 randomized controlled trials were evaluated. 3 trials demonstrated that immersive virtual reality improved upper limb activity, function and activity of daily life in a way comparable to CT. 18 trials showed that NIVR had similar benefits to CT for upper limb activity and function, balance and mobility, activities of daily living and participation. A comparison between the different forms of VR showed that IVR may be more beneficial than NIVR for upper limb training and activities of daily life. Conclusions: This study found out that IVR therapies may be more effective than NIVR but not CT to improve upper limb activity, function, and daily life activities. However, there is no evidence of the durability of IVR treatment. More research involving studies with larger samples is needed to assess the long-term effects and promising benefits of immersive virtual reality technology

Secondary outcome (health-related quality of life) of the studies included.

Secondary outcome (health-related quality of life) of the studies included.</p

Database research strings.

PurposeTo investigate the role of pelvic floor devices (e.g., biofeedback, electrical stimulation, magnetic stimulation, or their combination) as adjunctive treatments in pelvic floor muscle training (PFMT) in stress urinary incontinence (SUI) after radical prostatectomy.Materials and methodsA systematic review with meta-analysis. We searched for randomised controlled trials (RCTs) and prospective non-randomised studies investigating the effectiveness of pelvic floor devices as an adjunctive treatment for SUI symptoms assessed with weight pad-test or standardised questionnaires. To assess the risk of bias (RoB) and overall certainty of evidence, the RoB 2.0 or the ROBINS-I, and the GRADE approach were used.ResultsEleven RCTs met our eligibility criteria. One was at a ‘low’ RoB, one had ‘some concerns’, while nine were at a ‘high’ RoB. Two meta-analyses were conducted to analyse the pooled results of six RCTs included. Specifically, two RCTs reported at week 4 with a 1h pad test a mean difference of 0.64 (95% CI = [-13.09, 14.36]), and four RCTs reported at week 12 with a 24h pad test a mean difference of -47.75 (95% CI = [-104.18, 8.69]). The heterogeneity was high in both analyses (I2 = 80.0%; I2 = 80.6%). The overall level of certainty was very low.ConclusionsIn line with our results, we cannot conclude whether pelvic floor devices add any value as adjunctive treatment in the management of SUI after radical prostatectomy. Future studies require more comprehensive and standardised approaches to understand whether these devices are effective.</div

PRISMA 2020 checklist.

PurposeTo investigate the role of pelvic floor devices (e.g., biofeedback, electrical stimulation, magnetic stimulation, or their combination) as adjunctive treatments in pelvic floor muscle training (PFMT) in stress urinary incontinence (SUI) after radical prostatectomy.Materials and methodsA systematic review with meta-analysis. We searched for randomised controlled trials (RCTs) and prospective non-randomised studies investigating the effectiveness of pelvic floor devices as an adjunctive treatment for SUI symptoms assessed with weight pad-test or standardised questionnaires. To assess the risk of bias (RoB) and overall certainty of evidence, the RoB 2.0 or the ROBINS-I, and the GRADE approach were used.ResultsEleven RCTs met our eligibility criteria. One was at a ‘low’ RoB, one had ‘some concerns’, while nine were at a ‘high’ RoB. Two meta-analyses were conducted to analyse the pooled results of six RCTs included. Specifically, two RCTs reported at week 4 with a 1h pad test a mean difference of 0.64 (95% CI = [-13.09, 14.36]), and four RCTs reported at week 12 with a 24h pad test a mean difference of -47.75 (95% CI = [-104.18, 8.69]). The heterogeneity was high in both analyses (I2 = 80.0%; I2 = 80.6%). The overall level of certainty was very low.ConclusionsIn line with our results, we cannot conclude whether pelvic floor devices add any value as adjunctive treatment in the management of SUI after radical prostatectomy. Future studies require more comprehensive and standardised approaches to understand whether these devices are effective.</div